Nursing Scholarship Application

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Applications Closed

Applicant Information

Full Name

Address

City

State

Zip

Phone Number

How did you hear about the scholarship program?

Why are you applying for this scholarship and what qualities do you possess that will make you a good healthcare professional?

Please describe your financial need with regard to your schooling and how this scholarship would help you financially'

What factors influenced you to choose this profession?

Why do you feel that Hutchinson Regional Medical Center is the employer you want to work for upon graduation?

Do you understand the work commitment expectation and are there any reasons why you wouldn't be able to fulfill your obligation?

How do you (or will you) contribute to quality patient care at HRMC?

What long-term personal, educational and professional goals have you set for yourself? Why did you choose them and how will you accomplish them?

References

Reference 1

Name

Relationship to Reference

Phone Number

Reference 2

Name

Relationship to Reference

Phone Number

Employment Information

Are you currently employed at HRHS?

Yes No

Current Employer

Employer's Address

City

State

Zip

Phone Number

Employment Dates

Position

Supervisor's Name

Education Information

Name of Current School

Starting Program Date

Anticipated Graduation Date

Current Grade Point Average

Disclosure

To support my application for the scholarship program, I am authorizing that any of my school records and employment history be verified by appropriate personnel of Hutchinson Regional Healthcare System who will retain such information in strict confidence, to the extent permitted by applicable law. I release Hutchinson Regional Healthcare System, its board members, officers, directors, agents, and employees from any and all claims and liability for damages related to the release of my records to Hutchison Regional Healthcare System. All of the statements made on the application for the scholarship program are true to the best of my knowledge. I understand that any falsification of fact is sufficient grounds for my rejection as an applicant or my termination of the scholarship program.

I agree to the above

Nursing Scholarship Application

Nursing Scholarship Application

Applications Closed

Applicant Information

References

Employment Information

Education Information

Disclosure

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